Hyperbaric oxygen therapy: from the nineteenth to the twenty-first century

Hyperbaric oxygen technology now occupies a legitimate place in modern medical practice, and the number of clinically active hyperbaric facilities has grown. We estimate that more than 200 monoplace (single-patient) chambers and over two dozen multiplace facilities are presently active in the United States. Nevertheless, the majority of patients suffering from syndromes amenable to HBO therapy are treated in hospitals devoid of such modalities. This situation stems in part from the significant cost of appropriate facilities, the relative scarcity of trained personnel, and the difficulties in obtaining appropriate compensation in an era of rapidly changing reimbursement paradigms. Frequently, patients undergoing HBO therapy require mechanical ventilation, vasoactive drug infusions, sophisticated monitoring, and accurate fluid and electrolyte therapy during treatment. The demonstrated efficacy of HBO as an important part of the treatment of certain acute disease processes, however, justifies the facilities and skilled personnel necessary for the care of critically ill patients in a hyperbaric environment.